LABORATORY ACTIVITY GENITOURINARY SYSTEM

Resource Person : Yani Triyani

Subject : Urinalysis
Department : Clinical Pathology

A Sequent
I Introduction : 40 menit
II Pretest : 5 menit
III Laboratory activity : 120 menit
IV Post test : 5 menit
B Topic:
1. Urinalysis
Date : November 2021
1. Discussion with specific topic : 50 menit
2. Work on urine collection and urinalysis : 70 menit

OBJECTIVE
At the end of the activity the students will be able to:
1. Understand and can describe about the general purpose and function of clinical pathology
2. Understand and can describe about pre analytical steps of urinalysis
3. Understand and can describe about analytical steps of urinalysis for renal diseases
4. Understand and can describe about interpretation and analysis of urinalysis results
5. Understand and can describe about interfering factors for urinalysis results
6. Understand and can describe about quality control of urinalysis

C Venue
Biomedical Laboratory, Faculty of Medicine, Unisba, Jl. Tamansari No.22 Bandung 40116
D Personal Protective Equipment and Equipment Examination
1. Gown/ Jas lab
2. Hands glove
3. Masker
4. Face shield
5. Container urine
6. Dips stick urine
7. Centrifuge
8. Objek glass
9. Cover glass
10. Tissue paper
11. Light microscopy
12. Atlas Urinalysis Microscopic

E Pre-requisite/ Pretest
Before following the laboratory activity, the students must prepare :
I. Describe the general purpose and function of clinical pathology laboratory
II. Describe pre analytical steps of urinalysis:
2.1 Describe why study urine
2.2 Describe of urine composition
2.3 Describe types of urine specimens and state at least one diagnostic use for each type
2.4 Describe the collection technique used to obtain the specimensfor urinalysis
2.5 Describe of urine specimen storage and handling

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 2.6 Describe is this fluid urine?

III. Describe analytical (methods) steps of urinalysis:

3.1 Basic (routine) procedure:

3.1.1 Physical examination of urine
3.1.2 Chemical analysis of urine (dipstick urinalysis)
3.1.3 Microscopic examination of urinary sediment

3.2 Automated urinalysis (nice to know)

3.3 Special testing and monitoring Techniques (Laboratory tests used to investigate stone
formers)

IV. Describe post analytical steps of urinalysis

V. Describes interfering factors for urinalysis results (false positive and negative results)

VI. Describe quality control of urinalysis

Note:
- Content lab in manual book ( pre and post test will be taken from the manual, if scorring pre test less
than 50, can not allowed the lab activity )
- Bring your text book, reference book about Urinalysis etc. ( minimal 1 group 1 atlas ).

F Implementation
1. Students are divided into 17 groups, each group is supervised by one tutor
2. Discussion all about urinalysis in 30 minute
3. Work on urinalysis and interpretation of urinalysis results 90 minute

Activity 1: Pre analytical steps of urinalysis

The general purpose and function of clinical pathology laboratory
• Confirming or rejecting diagnosis
• Providing guidelines in patient management
• Establishing a prognosis
• Detecting disease through case finding or screening
• Monitoring follow up therapy

Describe pre analytical steps of urinalysis:

Why study urine?
Urine is actually a “fluid biopsy” of the kidneys and can provide a fountain of information about the
health of an individual. The kidneys are the only organs that can have their functional status evaluated by
such a noninvasive means. In addition, because urine is an ultrafiltrate of the plasma, it can be used to
evaluate and monitor body homeostasis and many metabolic disease processes.3

A significant amount of information can be obtained through the examination of urine. Careful
examination enables the detection of disease processes intrinsic to the urinary system, both functional
(physiologic) and structural (anatomic), and sometimes unsuspected. The progression or regression of
various lesions can be monitored with only minimal distress to the patient. Furthermore, systemic disease
processes, such as endocrine or metabolic abnormalities, can be detected through the recognition of
abnormal quantities of disease-specific metabolites excreted in the urine. Laboratory urine tests will
continue to play an essential role in clinical medicine. The purpose of this chapter is to highlight the
pertinent information that can be provided by the most common urine tests. Two main types of urinalysis

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are currently performed. These include (1) the dipstick (reagent strip) urinalysis, which is commonly
performed in screening laboratories, in physician offices, and as patient home testing; and (2) the basic
(routine) urinalysis, which adds a microscopic examination of urine sediment to the reagent strip
urinalysis.1

Describe of urine composition

• Describe types of urine specimens and state at least one diagnostic use for each type

• Describe the collection technique used to obtain the specimensfor urinalysis 3

Describe of urine specimen storage and handling 3

Storage (Container)

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 Fig. Container Urine

Labelling

Handling and Preservation

Describe is this fluid urine?3

Activity 2 : Analytical steps of urinalysis

GROSS/PHYSICAL EXAMINATION3

Color3

Foam3

Clarity3

Odor

Taste

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Concentration-Specific Gravity (SG)

Result SG used refractometer:

Results SG used dipstrick urine:

Volume

Chemical analysis of urine (dipstick urinalysis)

A reagent strip or dipstick consists of reagent-impregnated test pads that are fixed to an inert plastic strip.
After the strip has been appropriately wetted in a urine sample, chemical reactions cause the reaction pads
to change color. At the appropriate “read time,” results are determined by comparing the color of each
reaction pad with the appropriate
analyte on the color chart.

Your chemical analysis of urine:

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Microscopic examination of urinary sediment1-3
Microscopic examination of urine, in conjunction with dipstick chemical analysis, aids in the detection of
renal and urinary tract disease processes. With microscopy, one can detect those cellular and noncellular
elements of urine that do not give distinct chemical reactions. Microscopy can also serve as a
confirmatory test in some circumstances (e.g., erythrocytes, leukocytes, bacteria) and yields new
information 66% of the time. In the routine laboratory, examination of the urine sediment is best reserved
and most useful for those samples with abnormal dipstick results.
To perform a microscopic evaluation of urine with competence, one must be knowledgeable of numerous
morphologic entities (e.g., organisms, hematopoietic and epithelial cells, crystals, casts). Also,
microscopists must be aware of the clinical relevance of urine findings, as well as the common chemical
abnormalities associated with microscopic interpretations. Discrepancies should be investigated before a
report is issued. The quality of the manual microscopic analysis of urine is dependent on the expertise and
experience of the examiner.
Centrifuged urine sediment should contain all the insoluble materials (commonly referred to as formed
elements) that have accumulated in the urine following glomerular filtration and during passage of fluid
through the renal tubules and lower urinary tract. Cellular elements are derived from two sources:
(1) desquamated/spontaneously exfoliated epithelial lining cells of the kidney and lower urinary tract, and
(2) cells of hematogenous origin (leukocytes and erythrocytes). Cellular and noncellular casts may be
seen; these are formed in the renal tubules and collecting ducts. Crystals of variable clinicopathologic
significance may also be present. Organisms (bacteria, fungi, viral inclusion cells, parasites) and
neoplastic cells represent elements that are typically foreign to urine; when detected, further investigation
is required.
“Normal” or reference values for formed elements will vary from one laboratory to another because of (1)
the variation in concentration of random urine specimens, and (2) the different methods used to
concentrate the sediment by centrifugation. No specific standardized procedure is used. Individual
laboratories have established their own reference values, often in conjunction with nephrologists and
nephropathologists.

The most common sediments urine,consist of:

• Organic sediments :
– Leukocyte
– Erytrocyte
– Cast (Hyalin, epithelial, granular, leukocyte, erytrocyte, fat, waxy, mix, fibrin)
– Epithelial
• Anorganic sediments :
– Crystal :
• Normal :
– Acid :
» Uric acid, calsium oxalat
– Alkaline :
» Triple phosphates, calsium carbonate, calsium phosphate
• Abnormal :
– Cystin
– Thyrosine
– Amorph
• Others :
– Egg (Helminthes)
– Parasite
– Bacteria
– Spermatozoa
– Mucus

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See Atlas Sediment urine reference No. 2 p. 142-175

Draw your microscopic urinalysis:

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 Laboratory Tests Used to Investigate Stone Formers

Activity 3 : Post analytical steps of urinalysis

Identifying and enumerating the components found in urine sediment provide a means of monitoring disease
progression or resolution.
Determining the point at which the amount of each element present indicates a pathologic process requires
familiarity with the expected normal or reference interval for each component. (See reference intervals of all
parameters in a complete urinalysis.)
Normally, a few red blood cells, white blood cells, epithelial cells, and hyaline casts are observed in the urine
sediment from normal, healthy individuals. Their actual number varies depending on the sediment preparation
protocol and the standardized slide system used for the microscopic examination. Because changes occur in
unpreserved urine, factors such as the type of urine collection and how the specimen has been stored also
affect the formed elements observed during microscopic examination.

Interpretation urinalysis results

Interfering factors urinalysis

Activity 4 : Quality control of urinalysis

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G References
1. Riley R S., McPherson R A. 2017, Chap 28 “Basic Examination of Urine “ In Henry’s Clinical
Diagnosis And Management By Laboratory Methods, 23ed Elsevier Inc, p 442─80
2. Mundt LA and Shanahan K. 2016, “Graff’s Textbook of Urinalysis and Body Fluids, 3ed Elsevier
Inc, p 72─142.
3. Brunzel NA. 2018, Fundamentals of Urine and Body Fluid Analysis, Fourth Edition, Elsevier Inc. p.
19─181